Doctoral Degrees (Paediatrics and Child Health)

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Browsing Doctoral Degrees (Paediatrics and Child Health) by Author "Du Preez, Karen"

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    Complementary surveillance strategies and interventions to inform a tuberculosis care cascade for children
    (Stellenbosch : Stellenbosch University, 2021, 2020-12) Du Preez, Karen; Hesseling, Anneke Catharina; Schaaf, Hendrik Simon; Naidoo, Prenavum; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Monitoring and evaluation is an integral component of tuberculosis (TB) control programmes. Children 0-14 years of age contribute substantially to the global TB epidemic, with an estimated 1 million cases and 233,000 deaths in 2017. The limited availability of age-disaggregated TB surveillance data for paediatric and adolescent populations and the lack of specific monitoring and evaluation approaches, hampers TB control efforts in these special populations. Challenges with the sources and the complexity of TB surveillance data in children compound the current limited monitoring and evaluation efforts for paediatric TB. Only 45% of the estimated number of children globally with TB were reported as diagnosed and treated by TB programmes in 2017. More than half of all paediatric TB cases globally were therefore either undiagnosed, or diagnosed but unreported to TB programmes. A TB care cascade framework has been used successfully in HIV and TB control efforts to identify specific gaps and to monitor the impact of targeted programmatic interventions and could also be useful for monitoring and evaluation of paediatric TB. In an effort to address the lack of monitoring and evaluation approaches for paediatric TB, I investigated the role of diagnostic and treatment surveillance strategies to inform two pillars of a paediatric TB care cascade for South Africa. My research quantified the overall paediatric TB reporting gap in South Africa, showing that nearly a third of South African children with TB are undiagnosed, or diagnosed but unreported. Age- and HIV-stratified analyses of a large national routine TB treatment surveillance dataset, spanning a 13-year period (2004-2016), identified young, HIV-infected children (0-4 years) and adolescents (10-19 years) as populations who require additional targeted TB control interventions in South Africa. Diagnostic surveillance conducted at a large tertiary referral hospital and a district-level hospital in Cape Town, South Africa, quantified the substantial burden and spectrum of paediatric TB routinely managed at these levels of care (~400 and ~170 children annually at each hospital, respectively). Surveillance of HIV-infected children and children with TB meningitis (TBM) proved valuable to monitor the impact of TB and HIV prevention strategies and of integrated TB/HIV care. Finally, my research addressed the hospital-reporting gap in a prospective hospital-based study, where an intervention consisting of a simple TB referral service significantly improved recording and reporting as well as linkage to care of children with TB. Including TB data from all hospitals in routine TB surveillance data will substantially reduce the hospital-reporting gap for paediatric TB in South Africa and improve the completeness of routine TB surveillance data. Mandating hospitals to report TB data will also assist with improving the accuracy of reporting on the spectrum of TB disease and HIV data in routine TB surveillance data, increasing the utility of surveillance data for monitoring and evaluation approaches. Together, this research highlights the importance of using multiple sources of data at different levels of health care to strengthen the accuracy and completeness of paediatric TB surveillance. The use of practical monitoring and evaluation approaches, such as a care cascade, can help to improve TB care and services for children and adolescents and will contribute towards achieving the ambitious global targets set for TB control.